Florence Nightingales Lady With The Lamp - 1544 Words

Florence Nightingale, often called the â€Å"lady with the lamp†, is well known for being a pioneer in the field of nursing (Selanders, L., 2015). Florence helped shape nursing into the respected profession that it is today, raising much awareness to the need for improvement in nursing care as well as improved conditions of hospitals and institutions serving the poor. Her effort in these areas was certainly remarkable, but it is only one piece of her large body of work. Little known by many was Florence’s work in the field of statistics and epidemiology. She did not settle for changing the profession of nursing and the environment in which care was provided, but rather Florence also used data collection and analysis to help recognize areas in which further improvement was needed. Florence and care at the individual and population level Florence Nightingale was a visionary ahead of her time, someone who saw things for the way they could be rather than just the way they were. One area in which she envisioned a change was in the conditions of workhouse infirmaries, facilities for the poor that were notorious for their filth and spread of disease (McDonald, L., 2006b). Florence recognized that skilled nursing care, along with proper organization and structure of workhouse infirmaries could significantly reduce the transmission of disease and, in fact, improve the overall health of the population being served (McDonald, L., 2003). Through undertaking the start of this reform,Show MoreRelatedFlorence Nightingale : The Lady With The Lamp936 Words   |  4 PagesFlorence Nightingale: â€Å"The lady with the lamp† The purpose of this project is to summarize five articles –theory of Florence Nightingale, the most recognized, famous, and beloved nurse. The impact of her work was detrimental for developing the modern nursing practice. The focus of her work was to ensure sanitary environmental conditions to contribute patient healthy. This value of historical knowledge obviously justifies what has been preserved across the generations, which nursing continues toRead More Florence Nightingale Essay1022 Words   |  5 PagesFlorence Nightingale Florence Nightingale, a well-educated nurse, was recruited along with 38 other nurses for service in a hospital called Scutari during the Crimean War in 1854 . It was Nightingales approaches to nursing that produced amazing results. Florence Nightingale was responsible for crucial changes in hospital protocol, a new view on the capabilities and potential of women, and the creation of a model of standards that all future nurses could aspire towards. Florence NightingaleRead MoreNursing Theory And Its Impact On Nursing899 Words   |  4 Pagesrevolves around (Power, 2016). One of these main theorists was Florence Nightingale, who singlehandedly brought public health to the world’s attention, through her sanitation efforts and work in wartime hospitals (Fee Garofalo, 2010.). In this article, we will outline the components of Nightingale’s theory as well as identify how it still impacts the nursing world today. Historical Background Florence Nightingale was born in 1820 in Florence, Italy, to which she is named from. She came from a very wealthyRead MoreFlorence Nightingale s Influence On Nursing999 Words   |  4 PagesBiography Florence Nightingale was born May 12, 1820 in Florence Italy. She was born the second child in an affluent family. Nightingale’s parents had afforded her with a formal education in her childhood. Florence set her sights on nursing as she felt it was a calling from God. Nightingale’s parents forbid her to go to into nursing as they deemed it to be of lower class, instead the family pressured her to marry a wealthy man and join upper class society (Cohen, 1984). In 1951 at the age of 31Read MoreContributions Of Florence Nightingale1234 Words   |  5 Pages Florence Nightingale is most commonly known for her great influence in modern Medicine, even did consults on queens and kings and when the Civil War came around the president asked her advice on how to help the injured soldiers, but she also was a great contributor to mathematics. Many people tend to overlook the fact the fact that Florence Nightingale is credited with developing a form of the pie chart now known as the polar area diagram, or occasionally the NightingaleRead MoreThe Light Of Times Of Darkness1262 Words   |  6 PagesThe Light in Times of Darkness by Vianey Maciel Known as the Lady with the Lamp, Florence Nightingale is one of the most well-known and admired pioneers of the health care reform. Defying everyone’s expectations, she gained an admirable reputation and recognition as an advocate for public health by organizing and revolutionized the role of nurses. Nightingale’s views of the nurse’s role also set the foundation of what became the guidelines of how medical attention is given today (Bornstein 42).Read MoreFlorence Nightingale : The Lady With The Lamp, And The Mother Of Modern Nursing1388 Words   |  6 PagesFlorence Nightingale Alyssa Rasmussen Great Falls College – MSU â€Æ' Known as, â€Å"the Lady with the Lamp,† and â€Å"the Mother of Modern Nursing,† Florence Nightingale was born in Florence, Italy, on May 12, 1820 (National Women s History Museum, n.d.). She was the youngest of two children born to William and Frances Nightingale (National Women s History Museum, n.d.). Florence’s family was very wealthy and were members of the social elite (UAB - Reynolds-Finley Historical Library, n.d.). Florence receivedRead MoreFlorence Nightingale and Her Effect on Society2440 Words   |  10 PagesFlorence Nightingale and Her Effect on Society Florence Nightingale was a national hero in Victorian England who shaped the role of women and the image of hospitals in society forever. Miss Nightingale had gained her reputation through the Crimean War where she served as one of the head nurses and saved hundreds of lives. When she returned from the war, she was greeted by the royal Queen Victoria and the society of England as a heroine. Punch magazine depicted Miss Florence Nightingale as aRead MoreThe Environmental Aspects Of Care908 Words   |  4 Pagessanitary treatment, and environment. The important principle of this theory is that the patient must be empowered and encouraged to take an active role in his own healing (2010). Selanders argued in this article the importance and commitment of Nightingale’s work associated with applicability in the nursing profession as well as the value of this historical knowledge which continues to justify teaching her legacy for generations. As time passes, nursing continues to apply in daily practice this valueRead MoreFlorence Nightingale : An Intricate World Of Healing, Caring, Knowledge And Advocacy1257 Words   |  6 Pagesknowledge and idea that helped shape nursing to what it is considered. One such theorist was nursing’s first environmental theorist, Florence Nightingale. According to Black and Chitty (2014), Florence Nightingale was born in 1820 to a prosperous English household. Her father educated her in many subjects such as: Latin, German, Greek, History and even Mathematics. Florence excelled in academics and wanted to further her studies by going to Kaiserswerth, Germany to study nursing. This was a huge deal

Thomas Paine Hai Great Republic Summary - 1694 Words

Paine, Thomas. â€Å"Hail Great Republic.† PoemHunter.com, 21 Sept. 2010, www.poemhunter.com/poem/hail-great-republic/. Thomas Paine’s â€Å"Hail Great Republic† was one of the first American patriotic poem created during the revolutionary moment when the Declaration of Independence was signed. This poem, that used the tune of â€Å"Rule Britannia,† gives us evidence of early ideas when America was ready to break apart from the British tyranny rule. In this poem, he commends this country as the â€Å"land of love and liberty† and hopes the paradise to â€Å"be [there] forever.† Even after praising all its beautiful natural landscape that gives hope for the perfect utopia, he contradicts the idea of freedom as he reflects some of Europe’s ideas. In the poem, he†¦show more content†¦One day, after the carnival, Montresor invites Fortunato to his family’s vaults to taste a new barrel of Amontillado that he had recently bou ght. After Fortunato falls for his trap, he carefully guides him through the damp vaults of his house, surrounded by dead bodies, till they reach the crypt, where Montresor conducts his action. He begins to build a wall to this crypt and traps Fortunato inside, left terrified and helpless. Fortunato has a hard time believing his situation, and hope that his is all a â€Å"joke† till the end. At last, after his final plea, Fortunato stops answering Montresor, even after his own calls. Montresor believes that his â€Å"heart has been sickened† with the damp vaults as he decorated the bones on his fourth wall. In the end of the story Montresor writes that for fifty years no one has disturbed them, and may he rest in peace. A part of American gothic, this type of horror story writing was used by american authors to write about the evils of society. Poe, Edgar Allan. â€Å"Eldorado.† Poestories, Poestories, poestories.com/read/eldorado. The poem â€Å"El Dorado† by Edgar Allen Poe is a tale of a quest to discover the mythical city of gold in South America named El Dorado. This story is a criticism to the American gold rush which caused millions of American to obtain wealth and pursue their ‘American dream.’ In the story, â€Å"a gallant knight† spends his life finding this paradise that is nowhere to be found; this eventually causes his heartShow MoreRelatedStephen P. Robbins Timothy A. Judge (2011) Organizational Behaviour 15th Edition New Jersey: Prentice Hall393164 Words   |  1573 PagesNetworked Organizations 20 †¢ Helping Employees Balance Work–Life Conflicts 21 †¢ Creating a Positive Work Environment 22 †¢ Improving Ethical Behavior 22 Coming Attractions: Developing an OB Model 23 An Overview 23 †¢ Inputs 24 †¢ Processes 25 †¢ Outcomes 25 Summary an d Implications for Managers 30 S A L Self-Assessment Library How Much Do I Know About Organizational Behavior? 4 Myth or Science? â€Å"Most Acts of Workplace Bullying Are Men Attacking Women† 12 An Ethical Choice Can You Learn from Failure

Engaged Leadership The New Public Service Managerialism Free Essays

string(80) " and behaviours that challenged the old gods of fabian paternalistic endeavour\." Engaged Leadership – The New Public Service Managerialism Dr Neil Wooding Director of Public Service Management Wales Commissioner for Equality and Human Rights (Wales) Journal of Finance and Management in Public Services. Volume 7 Number 1 39 Dr Neil Wooding Engaged Leadership – The New Public Service Managerialism Abstract In the significant challenges that face managers and leaders to reform and improve Welsh public services this article examines a new leadership behaviour emerging that combines a different set of competencies from those managers have been exhorted to develop in the past. Under pressure to reform delivery, improve resource management and develop new models of governance, premised upon better collaboration and engagement with stakeholders and citizens, managers and leaders are faced with the task of lifting performance beyond the execution of traditional process. We will write a custom essay sample on Engaged Leadership: The New Public Service Managerialism or any similar topic only for you Order Now The article explores some of the features of this evolving style of leadership as a framework to encourage managers to rethink and refresh their knowledge, skills and experience in the context of the changing needs of public services. These challenges are set within an emerging paradigm described as ‘engaged leadership’.This concept is used to contrast a style of management which is open, inclusive emotionally intelligent and connected with what may be represented as counter intuitive to the traditional ways managers have tried to facilitate and maximise the performance of others. Introduction In the significant challenges that face managers and leaders to reform and improve Welsh public services we are beginning to see a new leadership behaviour emerge that combines a different set of competencies from those we may have exhorted managers to develop in the past.Under pressure to reform delivery, improve resource management and develop new models of governance, premised upon better collaboration and engagement with stakeholders and citizens, managers and leaders are faced with the task of lifting performance beyond the execution of traditional process. This article explores some of the features of this evolving style of management as a framework for encouraging managers to rethink and refresh their knowledge, skills and experience in line with the changing needs of public services. For reasons that will become apparent, I have chosen to describe this newly emerging paradigm as ‘engaged leadership’.It reflects a move towards a relational mode of management that we might describe as open, inclusive, emotionally intelligent and connected. For many managers and leaders this represents a counter intuitive challenge to the traditional ways we have tried to facilitate and maximise the performance of others. Before describing this change in management and leadership practice, this article will begin by focusing upon the public service context in Wales and the demand this is placing upon Welsh managers and leaders to develop a wider and more relevant skills port folio.Within a trans-national context, the challenges faced by managers in Wales are not dissimilar from those faced by men and women leading and managing services in other parts of the UK. We can of course find variations in the wider public service policy context often described as the ‘cle ar red water’ (Morgan, 2002) distinguishing the philosophy and principles underpinning public service delivery in Wales from that in England, however within a local context the challenges faced by managers and leaders are broadly similar to those outlined above.Implicit in this analysis of some of the emerging development needs of managers and leaders is a recognition that to learn to do something differently one must occasionally unlearn or discard those practices and behaviours that no longer serve a clear and useful purpose. These manifestations of management and leadership behaviour reflect the accumulative knowledge individuals have acquired over the course of their careers to meet the imperatives of the past. It is not that they have become discredited but that anachronistically they serve another time and space.Addressing the tension between the old and new forms of management is often the most difficult and contentious stage in the process of acquiring new skills and knowledge. The sentiment associated with the ritual and tradition of long held beliefs and practices can often challenge and occasionally defeat the rational logic we use to lubricate organisational change. Journal of Finance and Management in Public Services. Volume 7 Number 1 41 Engaged Leadership – The New Public Service ManagerialismDr Neil Wooding For the purpose of this article, the terms management and leadership are used interchangeably to reflect the fact that while they are functionally distinct and separate, the same individual often performs both roles. In practice, managers spend some of their time leading and leaders spend some of their time managing. Deciding within a situational context when to manage or to lead is the critical factor determining the success of each (Heifetz and Linsky, 2002).This notion embraces the belief that leaders emerge often within real time and for a specific purpose as well as through more conventional processes of assignment (Hardcore, 2002). The public service context in Wales It is clearly evident to those engaged in management and leadership development that the current pressures to reform public services represent a burning platform on which managers and leaders are having to evolve and adapt or cease to exist.The improvement agenda unfolding across Welsh public services is all encompassing and paradigmatic, reflecting root and branch reform at a systems-wide cultural and structural level. In this respect, the terms of reference underpinning the way managers and leaders will need to operate in the future are being re-written into the evolving blue print of public service reform itself. For those of us who can remember, this move towards a new way of doing management is not a new ritual but one that we have honoured in the recent past.During the 1990’s a new public managerialism emerged in response to a decade of iterative public service reform (Exworthy and Halford). With its emphasis upon competitive models of service delivery and business transaction, coupled with explicit measures of performance and service dis-aggregation, managers were inculcated with a set of values and behaviours that challenged the old gods of fabian paternalistic endeavour. You read "Engaged Leadership: The New Public Service Managerialism" in category "Papers" Drawing upon private sector technologies to deliver public service outcomes became the modus operandi of a new generation of managers and leaders.It is in the context of this management dialectic that a new model is emerging to challenge established beliefs and practices about what managers and leaders must do to deliver improved services. Within Wales, the public service improvement agenda has become the dynamic underpinning reform at all levels of service delivery and across all sectors. These changes are not confined to individual organisations alone but the wider public service community as a series of intera cting and collaborating agencies collectively responsible for the social and economic wellbeing of the wider population.This includes Local Government, the NHS, the Civil Service, Assembly Government Sponsored Bodies and in some cases Non-devolved Government Departments. Within the context of this systemic transformation, managers and leaders have assumed by design or in some cases default the central role in making change happen. Their primary purpose is to initiate change and reform within the public service value chain and to manage the tension of maintaining systems equilibrium during a destabilising period of transformation.In the context of public service reform, the responsibilities placed upon managers and leaders to meet the challenge of change requires that they exceed their authority and risk their personal significance to succeed where others would or have failed (Heifitz and Linsky, 2002). This venture into unmapped territory requires a significant shift in the self-perception and awareness of managers who may have traditionally considered their role to be defined in terms of control and systems maintenance.At the current time approximately 304,000 people work within public services in Wales (Public Service Employment Digest, 2005). A conservative estimate would suggest that between fifty and sixty thousand individuals carry a responsibility for managing or leading others. This figure is growing as the imperative to improve day to day performance increases in line with the expectations 42 Journal of Finance and Management in Public Services. Volume 7 Number 1 Dr Neil Wooding Engaged Leadership – The New Public Service Managerialism e place upon our managers and leaders to deliver outcomes. Unfortunately investment in management and leadership development remains fairly static as budgets continue to be determined by resource availability rather than resource need (Smith, 2007). Current per capita expenditure is as low as eighty pounds per head inside a number of public service organisations. This level of investment falls significantly below the European average and confirms the fact that within the UK we spend less on management development than any other major post-industrial economy (ibid).The disparity between the lower level of productivity within the UK compared to other countries, approximately 20%, has been attributed to the level of investment in management and leadership development. Within a public policy context, the impact of the review of Welsh public services by Sir Jeremy Beecham and the subsequent publication of Beyond Boundaries: Citizen-Centred Local Services for Wales (Beecham, 2006) upon the nature and scope of the public service improvement agenda has been considerable.Identifying the key themes of culture, complexity and capacity to encapsulate the challenges facing Welsh public services, the report serves to reinforce the case for wide spread reform in relation to a number of critical themes. These include improving citizen focus and engagement, building robust and durable partnerships at an individual and organisational level. Also generating better use of resources to make the Welsh pound go further and developing models of governance that unshackle creativity and support the emergence of a prosperous and fully formed Welsh nation state.The challenges that face Welsh public services and perhaps more importantly the managers and leaders who must deliver improvement include breaking away from cultures that are driven by compliance, protectionism, competition and opacity. These facets of Welsh public service culture have in general stifled innovation, disguised weak or poor performance, encouraged shortermism and constrained diversity. In relation to the issue of capacity, the lack of leadership skills featured highly within the review.Significant skill deficits were evident in the field of communications, partnership working, general management, innovation and creativity, and stakeholder engagement. The consequence of these capacity constraints were evident in the comparatively poor performance of welsh pu blic service organisations. Within the review itself, Beecham attributed the gap between policy aspiration and service delivery to unnecessary complexity in the governance process, citing ‘variable geometry’ and the complexity of the delivery map as a net contributor to poor service performance. The prevalence of competing jurisdictions and often overlapping boundaries created a climate of ‘busyness’ that compartmentalised responsibility, encouraged boarder patrol and detracted from the real business of delivery. This in turn, led directly to significant amounts of confusion and obfuscation within the value chain. Within the context of creating better and more efficient use of resources, the review recommended that leaders develop their ability to work beyond the boundaries of their formal authority to embrace the additional roles of enabler, contractor and co-producer.This expansion of the role of public service leaders was directly connected to establishing new models of governance delivered through partnership and collaboration. In response to the review itself and the recommendations it proposed, the Welsh Assembly Government published a programme of action in the autumn of 2006. This included the establishment of Local Services Boards operating as regional partnerships between NHS, Local Government and third sector organisations within specific localities.Officers of the Welsh Assembly Government would attend partnership boards to support the collaborative process, Journal of Finance and Management in Public Services. Volume 7 Number 1 43 Engaged Leadership – The New Public Service Managerialism Dr Neil Wooding provide a vehicle for communication and help maturate the dialogue between key players. To date, six Local Service Board pilot projects have been established across Wales to explore the boundaries and test the feasibility of this new model of working.Early indications suggest that the themes of shared governance, resource management, service integration and in some instances reconfiguration and re-organisation, loom large on the Local Service Board agenda. A further programme of action involved developing a range of learning interventions to support managers and leaders acquiring new skills and knowledge. This has resulted in a range of new learning experiences including international placements to sub-Saharan Africa; scholarships to the J. F.Kennedy School of Government at Harvard University, public service summer schools for up to three hundred managers and a new post-graduate pro gramme in public service collaborative leadership to be launched in the spring of 2008. From the perspective of public service managers and leaders, the impact of the Beecham Review and the establishment of Local Service Boards albeit embryonic at the current time, evidence an intention on the part of Welsh Assembly Government to reform in a whole systems way, the nature and function of Welsh public services.The personal and professional challenges emerging from this change process for individual managers and leaders broadly fall within four domains. They are not in themselves mutually exclusive but reflect the degree of emphasis placed upon particular aspects of the improvement agenda and the underlying areas of competence to which managers must in future aspire.They are: †¢ †¢ †¢ †¢ Working collaboratively and in partnership between the prescribed boundaries and beyond the traditional authority of public service organisations; Engaging stakeholder communities including the public service workforce, the service user, other providers and the citizen in a co-productive, meaningful relationship; Developing new technologies to manage the tension and dynamic between risk, governance, creativity and innovation; Finding ways to make sense of the change process for others and to influence outcomes and meaning beyond the realm of immediate control.What is engage leadership and why is it important? The four development themes detailed above are significantly removed from the traditional fields of competence individuals have sort to acquire to develop and improve their performance. Not only do they re-direct managers and leaders towards a different set of priorities, they also focus upon developing new perspectives and patterns of personal behaviour that place relationships and human engagement above the totemic importance of organisational process. In this context, managing organisational complexity and ambiguity has become ritical to harnessing the energy and intangible asset base of public services. The concept of engagement describes the ability to step beyond the pale of organisational structure and process to interact and participate in ways that connect and engage human endeavour. To create a sense of shared mission among disparate communities and interests. It acknowledges that within today’s complex and ambiguous work environment not all things can be transacted through prescribed processes, that success is contingent upon developing new forms of social and human interaction which incentivise and harness individual enterprise.Recent research has suggested that only 13 to 14% of the workforce is fully engaged, 22% are completely disengaged and the remaining critical mass of approximately 65% strategically manage their disengagement. The consequences of disengagement for organisations are profoundly damaging. As part of its 2006 International Survey of employee engagement, Blessing White found 44 Journal of Finance and Management in Public Services. Volume 7 Number 1 Dr Neil Wooding Engaged Leadership – The New Public Service Managerialism hat individuals who were not fully engaged in delivering the goals of an organisation were likely to be ‘spinning, settling or splitting’ (Blessing White Inc. , 2006). Those that were spinning were wasting their talents and skills on tasks that were not sufficiently important and below their ability. Those that were settling had already reached a plateau in the level of their contribution and were either waiting for something better or entering semi-retirement.Those that were splitting had made the decision to leave and were in the process of actively seeking other employment opportunities. An estimate of the financial costs of disengagement to the Welsh economy based upon a proportion of the UK as a whole is calculated to be in the region of 1. 4 billion pounds. This represents the actual cost of managing the effects of employee disengagement and the diminished capacity within organisations for achieving higher levels of efficiency and effectiveness. These costs represent the cumulative effect of low level productivity, workplace absence, a higher than average prevalence of organisational disruption and conflict, cultural inertia and insularity, recruitment and retention difficulties, change aversion and diminished innovation capacity. The reasons why individuals disengage include dissatisfaction with the way they are treated by their line manager, pay inequity, lack of development opportunities and over-regulation and control (ibid). It is well documented in the research base underpinning this phenomenon that individuals join organisations but leave their managers.Ensuring individuals are full engaged and motivated is a critical role for managers and leaders. The concept of ‘engaged leadership’ is a summary description of the skills and knowledge necessary to address the four domains outlined above. Measured in terms of the ability to create impact and outcome through others, an engaged leader is defined as someone able to operate in the here and now, to manage in the moment, or as Senge has suggested, to be fully present in a physical, emotional and intellectual way at the right time and in the right place (Towers Perin, 2006).Engaged leaders operate in real time, seeking outcomes and solutions that are delivered at the point when they are most needed. They utilise the energy and power of the present to generate outcomes that are not constrained by the past or contingent upon the future. Their engagement and connection with others is a liberating interaction beyond the realm of formal control. They build strong and powerful connections with people, places and principles to become the embodiment of the change process itself. At any one time they are the object and agent of change.Engaged leaders are emotionally intelligent. They exercise intuitive judgement based upon profound self-awareness and knowledge of others. They are reflexive and self-learning. They use their personal and professional authority to connect others to the goals and outcomes of the organisation. They are often described as innovative, approachable, honest, passionate and adaptable (Senge et al, 2005). Unconstrained by boundaries and less committed to pre-defined plans, they are prepared to risk their personal status and credibility to secure change for the good of all.In the next section of this article we shall look at the four areas of leadership competence that underpin this emerging model. They are depicted in the following graphic as narrative leadership, connected leadership, collaborative and thought leadership. Within the context of becoming an engaged leader or manager they are co-dependent themes existing within their own right but often indistinguishable in the process of operationalisation. For instance, a manager who is a good storyteller will use their sense-making skills to influence the thoughts and behaviours of others. They are likely to build and invest in relationships using the techniques of thought leadership to promote connectivity and collaborative practice. However for the purpose of this article it is useful to explore each theme individually to map the skills and attributes that constitute engaged leadership. Journal of Finance and Management in Public Services. Volume 7 Number 1 45 Engaged Leadership – The New Public Service Managerialism Dr Neil Wooding Figure1. A model of engaged leadership Narrative Leadership In today’s complex and often ambiguous work environment managers and leaders must make sense of change for others.Narrative leaders and managers tell stories to communicate change to others. A story becomes real when different events or incidents are connected to each other and placed within a social context to signify meaning. Storytellers make sense of social phenomena for others. Through illustration, they provide the context and rationale for why things happen and offer an account of a different type of future that might be unimagined by the listener. An example of contemporary storytelling that has had a profound impact upon those who have listened is Al Gore’s narration of ‘An Inconvenient Truth’.With the alacrity of the Ancient Mariner he has on innumerable occasions told the tale of environmental destruction to enraptured audiences across the world. His story is simple, profound, thought leading and durable both historically and culturally. Within the context of organisations and the workplace itself, story-telling can be a vehicle for inspiring and driving organisational change. Stories can help to tell the truth of organisations, clarifying and simplifying the complexity that often obscures organisational processes and behaviours. They help to expose the unwritten customs, rituals and practices embedded in the culture of organisations. Stories are sense-making devices that bring people together around a shared language and imagery. Telling a story can help to unite aspirations and promote commitment. To bring about both cultural and structural transformation, leaders and managers must extend their reach into those parts of the organisation where control and authority is often weakest. Stories can 46 Journal of Finance and Management in Public Services. Volume 7 Number 1 Dr Neil WoodingEngaged Leadership – The New Public Service Managerialism span both the formal and informal space (The Hay Group, 2007) inside organisation. They link the official structures, systems and processes with the culture, internal relationships and micro-politics of the workplace. Storytellers manage the tension between orthodox ways of doing things and radical alternatives. They help to build a platform for change by liberating the imagination of individuals to do things differently. Telling stories can serve many purposes within an organisation. They can help to improve communication and promote innovation.They facilitate the transfer of insight and knowledge across organisations, building community and aiding collaboration. Stories enable individuals to externalise their fears and aspirations and to advocate on behalf of others. To tell stories well, managers and leaders must be able to draw upon a personal library of knowledge and information to narrate an event or incident that resonates with the interests, ambitions, values and beliefs of the listener. The art of a good story is in the telling, timing and relevance. It should enable the listener to access his or her own depository of self-knowledge and experience.To enhance the performance of others through storytelling, managers and leaders must ensure the stories they tell are well constructed, realistic and not too prescriptive. Engaging individuals in the process of storytelling is enabling them to find their own truth and meaning. The language used to narrate the story must also be accessible and not value laden. Telling stories for the sake of telling stories is not a useful enterprise it will deter listening and devalue the experience. For this reason, narrative leaders must focus upon the use of stories as a device to shift perspectives and change minds. In the context of transforming organisations though the individuals who work within them change from a management and leadership perspective is often about managing meaning. Finally, stories that are too long are likely to bore and frustrate the listener. The best stories are often of less than two minutes duration. Storytelling is a tool of engagement. It enables those responsible for managing and leading others to build connectivity with individuals and communities by sharing personally relevant experiences. It promotes trust and awareness of others, encourages others to tell their story, and acknowledges the agentic role of the individual.Thought Leadership Influencing the thoughts and behaviours of others is a difficult and demanding task for many managers and leaders working within public services. This is partly because of the sheer volume of organisational traffic and ‘busyness’ that often undermines the clarity of purpose individuals need to do their job well. The ability to influence others is further exacerbated by the complexity of organisational structures and processes and the ambiguousness of modern hierarchies no longer predicated upon time served ritual and practices.Lines of accountability are less formal than they may have been in the past and the power to control the behaviour of others less absolute and authoritative. In this environment where issues and priorities compete for attention, the ability to influence others in what they think and do has significant currency. It requires the ability to use language and conversation to capture the attentive interest and concentrate the thought of other parties often beyond the terrain of formal control.To affect individuals in terms of their thoughts and feelings is not difficult to achieve. A brief consid eration of the conversations we have had in the past after which we might have changed our minds or altered our view of the world would testify to this. However, effective thought leadership is not a game of chance or opportunity. It requires an understanding of the direction that particular thinking habits travel and of the social thinking process itself (Polkinghorne, 1988) If we wish toJournal of Finance and Management in Public Services. Volume 7 Number 1 47 Engaged Leadership – The New Public Service Managerialism Dr Neil Wooding change the way people think we need to address the deep structure of our conversations with other. This is often hidden or submerged beneath the cultural veneer that determines our social interactions. In his analysis of what makes a successful thought leader, Ryde offers six forms of conventional thinking that form the basis of dialogue between individuals inside organisations.They are as follows: †¢ †¢ †¢ †¢ †¢ †¢ Deficit thinking – thinking that focuses upon the problems or weaknesses of a proposition; Rational thinking – thinking that gives disprop ortionate emphasis to the logical or sequential; Sticky thinking – thinking that attracts other ideas or thoughts in much the same way as word association but which is not incremental or evolutionary; Commonsense thinking – thinking that involves the application of generalised knowledge without insight or expertise; Binary thinking – thinking that encourages oppositional ideas or focuses upon the definitive differences that distinguish and separate one thing from another; Equity thinking – thinking that uses the concept of fairness as a construct upon which to evaluate and determine all other things. Each of these different thinking technologies has significant merit in relation to influencing the thoughts and behaviours of others. They are the tools we use everyday in our conversations with colleagues to convey out thoughts and ideas and more importantly convince others of their value. Often we will use them to progress our own ideas and simultaneously to devalue or weaken the arguments and views of others where we feel we may be in competition.They will be used to advance and defend those things that we believe in and wish to share with others. However to be truly effective, Ryde suggests thought leaders must expand each thinking style to incorporate a corresponding or alternative way of thinking. In the case of deficit-thinking, this must be strength-based thinking, encouraging individuals to build on the merits of a proposition and not just dismantle or diminish it. For rational-thinking, the alternative is feeling-thinking, an approach that advocates an intuitive and emotional perspective to balance the use of logic and rationality. To enhance the benefit of common sense-thinking, insight-thinking is used to weight the analysis of any proposition with expertise and wisdom. As an alternative to binary-thinking, re-integratedthinking can be used to create a third option and reconcile what on the surface seem to be diametrically opposed views. 360 degree-thinking can help to expand the narrow interpretation often given to issues of equity. Finally, exit-thinking can be used to recalibrate a conversation and stall the technique of sticky-thinking (Ryde, 2007). Developing an a personal toolkit of thinking techniques can help considerably to influence others. The impact of using these skills is multiplied when thought leaders focus upon the process of thinking itself and the use of language in the context of maintaining a clear sense of the purpose of the conversation. Connected Leadership Engaging individuals as a connected leader builds on some of the key skills identified above.But to be effective, these must be exercised in the context of managers and leaders being prepared to take a personal risk to achieve outcome, to influence others towards positive engagement with a key goal and to facilitate a sense of being supported and challenged within teams and individuals (Gobillot, 2007) These skills are critical in leading others through the process of change. Connected leaders bridge the divide between the formal organisation, its rituals processes, structures and goals and the real organisation which embodies the social networks and human asset 48 Journal of Finance and Management in Public Services. Volume 7 Number 1 Dr Neil WoodingEngaged Leadership – The New Public Service Managerialism base underpinning service delivery. Creating synergy to harness the energy and intelligence of the real organisation in pursuit of the goals of the formal organisation is the primary task of the connected leader. As public service managers and leaders we are constantly aware of the importance of communication and the dislocating effect of failing to message individuals sufficiently well to foster engagement. This task is often made more difficult by a long established culture of separatism that stratifies the provision of services using linear patterns of design and delivery premised upon unilateral accountabilities.Developing connectivity acro ss the terrain of service delivery is vital for the production of high quality services based upon the engagement of all stakeholders. Gobillot suggests that many leaders become exceptionally good at reading and responding to the situation in which they find themselves but fail to intuit the wider context in which situational change is occurring. This is a consequence of responding almost exclusively to priorities that are localised and short term. To balance these competing interests connected leaders must rely upon the knowledge and insight of individuals who work beyond the environment they are responsible for leading or managing.They must create trusting environments to enable individuals to manage the risk of co-creation with customers and service users and instil relationships with meaning to unite stakeholders around a single agenda. Finally, they must learn to bank the trust and confidence of others by investing in relationships so that when the going gets tough they can draw upon a personal credit account of authority. For the connected leader, engagement is secured by developing conversations that are deep structured, meaningful and authoritative. This approach rests on the knowledge that the desire for meaning and fulfilment is best met by building a co-productive relationship between the service supplier and serv ice user. Observing the kinds of conversations that take place within and across public services will often reveal a pattern of dialogue shaped by personal mperatives such as boundary management, risk aversion, trust deficit, short-termism and individual and organisational status. Developing conversations that are value driven, outcome focused and sustainable will help to secure higher levels of engagement with all stakeholders and lead to more meaningful outcomes. Collaborative Leadership Public services are inextricably linked in one way or another to each other. The strength of this connection is most obvious and real when the citizen or service user is placed at the centre of service delivery where it becomes self-evident that services are not only linked together but they are also contingent upon each other.For managers and leaders, developing an integrated approach to service delivery requires a commitment to collaborative working, the appropriate enabling skills and a capacity to determine outcomes beyond the pale of traditional authority. Leaders and managers who display high authority thresholds, where they risk their status and personal significance, are open to challenge by others and who can deliver outcomes within an environment where the rules a nd conditions of play are not within their direct control are likely to prosper in circumstances where working with others is essential for delivery. Using the skills outlined above will help to provide a platform for leaders and managers to develop strong collaborative practice and venture in their aspirations beyond traditional boundaries.However the capacity to operate successfully beyond the realm of ascribed authority where individuals have to use their personal power to influence the behaviour and actions of others requires a shift in perception that on the surface contradicts traditional ideas of what managers and leaders do. The most immediate differences are in relation to control and needs awareness. Journal of Finance and Management in Public Services. Volume 7 Number 1 49 Engaged Leadership – The New Public Service Managerialism Dr Neil Wooding Control within organisations is often absolute and includes resources, such as money, time, and physical effort. The more complex and process driven organisations become the greater the need for systems of control to maintain and regulate performance.This inevitably becomes the main preoccupation of managers and leaders who are concerned with meeting the goals of the formal organisation. Similarly, recognising the needs of other organisations or stakeholders as valid and equal to one’s own, challenges the legitimacy of individuals to act in self-interested ways. Putting other organisations before the needs of one’s own even in the interests of delivering an integrated solution is often a necessary precursor to working in partnership. Within this context, managers and leaders often presume that because they operate successfully within the confines of their formal control they are able to achieve the same outcomes with the same mode of operation in other environs.To operate effectively collaborators require an awareness of the needs of others and a recognition of the legitimacy of different thoughts, values and ways of doing things. Middleton suggests that most managers are trained to be effective within the realm of their personal control and not within the wider sphere of their organisation or community (Middleton, 2007). Outside the context of their immediate hierarchical control there is often greater plurality and equanimity resulting in a greater degree of ambiguousness. This is often a consequence of alternative realities and constructs representing different cultures, organisational structures and power relations. To be effective in these circumstances, managers must display courage, humility and self-beli ef.They must try to brand themselves beyond their assigned role so that others value them not for the organisation they represent but for what they personally bring to the situation. This includes being able to articulate passion and to resonate with different aspirations and agendas. Finally managers and leader must be prepared to listen to the dialogue, the tone, context, substance, meaning, and the message to guide their response. Developing a new awareness of others will provide infinite opportunities for engaging in collaboration. Underpinning one’s personal leadership and management style with an acknowledgement of the difference of others will help to build a shared currency of understanding and transform the nature of the dialogue between key partners. Conclusion The challenge that lies ahead of public service anagers and leaders is significant. Both in relation to the level of transformation necessary to bring about public service improvement and the skills that individuals will need to acquire to deliver such change. Becoming more effective in yesterday’s management and leadership skills will not serve the purpose of sustainable public se rvice improvement. This requires a different level of personal and professional development that addresses the need to be more engaged as a leader and manager in the transformation process. 50 Journal of Finance and Management in Public Services. Volume 7 Number 1 Dr Neil Wooding Engaged Leadership – The New Public Service ManagerialismThe seeds of this emerging model of leadership are already germinating within public services, as managers and leaders explore new ways of working with each other, the workforce, service users and the citizen. The learning components of this new engaged model of leadership include developing narrative skills to manage the meaning of change and cultivate participation; becoming effective as a thought leader, to influence through dialogue the beliefs and practices of others; connecting with communities, to broaden understanding of the need of others and facilitate better opportunities for co-production; and finally working collaboratively to maximise service value and improve partnership working.Generating new approaches to leading and managing organisations to promote better engagement will challenge the prevailing culture of risk aversion and the sacredness of existing public service rituals and practices that act against the interests of the wider public as service users and citizens. Distinguishing between those practices that help to deliver improvement and those that hinder progress will underpin the transformation process. Demonstrating the courage and commitment to take action in the face of hostility or disaffection will hallmark its success. Ultimately, managers and leaders must act in the service of the improvement agenda delivering insight and inspiring others to deliver. How to cite Engaged Leadership: The New Public Service Managerialism, Papers

Logistics Article Review free essay sample

It discusses how critical the supply chain is to global trade and world welfare and that it is estimated that the consequences of disruption to the global supply chain, whether from terrorist or natural causes, can be in the range of hundreds of billions of dollars (Sarathy, 2007). It explains that TSM is a framework for mitigating security risks; prescribing best practices along the firm’s entire value chain (Chapter 1. Supply Chain Management) (Sarathy, 2007). It is used to help firms cope with all the possible sources of disruption that can happen in a supply chain, such as terrorist attacks and hurricanes. It also goes on to explain that TSM is broad in coverage, linking security to the entire range of value-added activities/ value added services (Chapter 3. Demand Management and Customer Service) across the supply chain (Sarathy, 2007). Aimed at both internal and external stakeholders, TSM as a common framework allows for easier collaboration among various supply chain participants and helps promote continuous improvement and innovation in nhancing security (Sarathy, 2007). We will write a custom essay sample on Logistics Article Review or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page In today’s global society, where everything is being traded over the internet and outsourcing and off-shoring (Chapter 5. Global Logistics) are becoming the norms; companies must concern themselves with the security practices of their partners if they hope to keep a thriving business. The logistics implications of this article are varied; in discussing TSM’s framework, it tells how it is built off the ideas inherent in the Total Quality Management (TQM) (Chapter 4. Procurement and Supply Management) approach, including building resilience into the supply chain and creating value from security initiatives. TSM requires all stakeholders be empowered to enhance security, suggesting that the firm push to obtain an organization-wide financial commitment to enhancing security (Sarathy, 2007). As supply chains become global the number of geographically scattered supply chain partners increases, also firms use a variety of infrastructure and transportation modes, so all the infrastructure operators are the firm’s partners (Sarathy, 2007). All of these various partners must collaborate and operate at the same high standard to obtain a high level of security across the entire supply chain (Sarathy, 2007). Since TSM involves initiating actions to avoid risk and to create and disseminate a value proposition that can justify the importance of security-related actions and investments, it holds that security practices are more likely adopted if they yield tangible benefits (Sarathy, 2007). It is suggested that the TSM approach can clarify the range of risk, making a firm less vulnerable to all the disruptions that can happen to a supply chain, like natural disasters, and can lead to marketplace recognition of the value enhancement of the firm from increased security and reduced vulnerability to disruption.

The Roaring Twenties free essay sample

Roaring Twenties The Roaring Twenties was period of continual economic prosperity and the distinguishing artistic edge in cities during the sass throughout the united States. For the first time in a long time, Americans lived in cities, rather than on farms. America was turned into a consumer society with the Nations total wealth more than doubling between 1920 and 1929. There was a rise in wages and real income, easy credit and installment plan buying, and in mass advertisement.Jazz and dance rose in popularity, and the twenties are sometimes known as the Jazz Age because of all of the blues in New Orleans and Memphis, with artists such as Lie Armstrong and George Gershwin. The 1 us was a time of economic and cultural prosperity which helped the twenties become a Golden Age throughout United States history. The united States and Canada became more anta-lamination in viewpoint during this period. The American Immigration Act of 1924 Limited Immigration from countries where 2% of the total U. We will write a custom essay sample on The Roaring Twenties or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page S. Population, per the 1890 census, not counting African Americans, were immigrants from that country. The substantial incursion of Europeans that had come to America during the first two decades of the century slowed down. The sass brought new styles of music into the typical American culture. Jazz became the most popular form of music for young people and the flapper culture. Famous jazz performers and singers from the 1 sass include Louis Armstrong, James P. Johnson, and Being Crosby.Prohibition made illegal the manufacture, import and sale of beer, wine and hard liquor, but it did not make drinking Illegal. Americans continued desire for alcohol under prohibition led to the rise of organized crime as exemplified by AY Capons. Speakeasies became popular and abundant as the Prohibition years progressed and led to the rise of gangsters such as Lucky Lucian and Sam Macho. They commonly worked with associates to organized crime and liquor smuggling. While the U. S.Federal Government agents raided such places and arrested many of the smugglers, they rarely managed to get he big bosses. The sass were a period of significant change for women as well. The 19th amendment was passed in 1920, giving women the right to vote, and women began to pursue both family life and careers of their own. America began to create her own culture and people began to spend money on more leisure activities, and through economic, cultural, and musical prosperity, the roaring twenties are able to represent Americas Golden Age throughout history.

A literary analysis of tea in Hope and Other Dangerous Pursuits

A literary analysis of tea in Hope and Other Dangerous Pursuits Free Online Research Papers The serving and the drinking of tea is part of the warp and woof of Middle and Far Eastern culture. Laila Lalami has taken pains to express the nuances that surround this Moroccan cultural feature. Tea is present at turning points in the plot or the thoughts of a character. It acts as a flag for the motif of unanswered questions and lack of resolution. Lalami’s emphasis of the social and emotional connection between the characters and tea is clearly revealed. The role it plays shifts between what I will term, the anesthetic, the apathetic and the amalgamator. Written by Kazuko Okakura, The Book of Tea gives the history and the philosophy of tea drinking in the Far East. Of the history he writes, â€Å"Tea began as a medicine and grew into a beverage. In China, in the eighth century, it entered the realm of poetry as one of the polite amusements.†(Okakura 1) He further states that out of the amusement grew a cultish adoration of tea. In chapter two of his book, he states that a person or a culture can be known by the little things that they do and enjoy, and that the vintages of tea and the methods of preparation reveal even more. It is upon this point that Lalami also focuses her attention. Laila Lalami has recognized that tea is used for more than quenching one’s thirst. She is aware of the cultural dynamic, the environments in which tea is consumed change as often as the characters. The anesthetic is first introduced in Larbi’s office environment (Lalami 20). Its use here suggests a daily habit that alludes to his personality, but more keenly points to his state of mind at the time. Larbi takes this drink before delving into his daily tasks. Lalami writes†¦Ã¢â‚¬ but for now he took his time reading the paper and sipping his tea† Choosing to momentarily partake of a Moroccan tradition in favor of zealously attacking his work can be viewed as a character trait. Tea helps us see that Larbi’s love for Morocco tends to shift, due to some personal desire to escape if not personally then vicariously. Lalami links Salma and the apathetic, she writes ,â€Å"Salma, for whom watching football was only slightly more exciting than waiting for a pot of tea to brew went to take a nap†(Lalami 25). This makes the reader aware of an adiaphoric bent in Salma. This will reveal itself further as Larbi and Salma attempt to deal with their daughter. Salma remains fairly aloof, primarily speaking at emotionally charged moments. The amalgamator is rebuffed by Larbi, when following a heated debate, he leaves the dinner table. â€Å"He didn’t say anything for the rest of the meal, rudely getting up from the table before tea was served† (Lalami 44). Here Lalami acquaints us with the idea that rejecting tea after dinner in Morocco is a cultural taboo. It is obvious that Larbi’s presence would have been both the polite and the traditional thing to do. Since Larbi dislikes Faten however, he could not bring himself to remain at the table especially when some of her rhetoric touched his conscience. Halima’s story begins with her leaving for her mother’s home to imbibe the anesthetic. â€Å"Fatiha made a pot of mint tea and served it†Ã¢â‚¬ ¦ (Lalami 53) In desperate need to find comfort, Halima goes to a place that she deems safe. Immediately, her mother acts as one might expect from a woman that has unquestioningly embraced all that Moroccan life tends to offer women. Her mother’s second statement isn’t made until after she lights the tea kettle! After taking her mother’s advice things temporarily get better for Halima. The amalgamator appears at ebb of the recurring flow of abuse. Lalami writes â€Å"After the children had gone back to school, Maati and Halima settled down for tea† (Lalami 61). Tea is never given his chance however, because abuse follows Halima’s questions about her husband loss of his job. Tea in Hope and Other Dangerous Pursuits follows the vicissitudes of life in Morocco. The Moroccan characters in book overlook its centrality as they overlook their roles in their varying story outcomes. Lalami, like the famed mint tea, draws the reader into a world that is rich with turmoil and fragrant with hope. Research Papers on A literary analysis of tea in Hope and Other Dangerous Pursuits19 Century Society: A Deeply Divided EraHonest Iagos Truth through DeceptionEffects of Television Violence on ChildrenComparison: Letter from Birmingham and CritoQuebec and CanadaThe Effects of Illegal ImmigrationThe Spring and AutumnAssess the importance of Nationalism 1815-1850 EuropeThree Concepts of PsychodynamicInfluences of Socio-Economic Status of Married Males

The Great Depression and African American Movements Essay

The Great Depression and African American Movements - Essay Example The Great Depression was addressed by President Roosevelt’s New Deal when he assumed office as a President of the United States on March 4, 1933. President Roosevelt’s New Deal involved a series of economic programs focused on Relief, Recovery and Reform of the economy not only to address the Great Depression but also to avoid the repetition of the same. Among the programs of his new deal was the obtained permission to reopen most banks and provided grants to citizens. He instituted government initiated work programs to generate employment through the Works Progress Administration (WPA) programs. President Roosevelt also pump primed the economy with the widespread public spending on infrastructure by constructing roads, buildings, dams and similar projects through his Public Works Administration (PWA) which provided not only jobs but income in the system. He also enlisted young men in the Civilian Conservation Corps to work on conservation projects.President Rooseveltâ €™s New Deal was to elevate both income and prices which dropped during the depression. When Second World War came in 1941, President Roosevelt shifted his attention to foreign policy to address the war. The war proved to be good for the US economy because the massive spending to build war machines double the country’s Gross National Product or GNP and reduced unemployment rate from 14% to less than 2%.The 1930s and 1940s saw the emergence of two African American religious movements which includes the Nation of Islam.

The Film Doctor Zhivago Essay Example | Topics and Well Written Essays - 500 words

The Film Doctor Zhivago - Essay Example Primarily, an entire social order is devastated and another of a cruel, forceful system is created to replace it. But such events are merely shown in a handful and violently acted parts that are shoved abruptly through a scene of the personal tragedy and afterward are as hastily inhibited. The greatest portion of this film is dedicated to the romantic view of the emotional connection and personal miseries of a few bourgeois who are inhumanely troubled and damaged by the larger forces of change. It seems that this tragic love story is the theme upon which the film has decided to resolve the pressures of personal drama and spiritual tension that overwhelmed the Pasternak narrative. I felt that the movie has taken for granted the massive disorder of the Russian Revolution for the sake of displaying the ordinariness and triviality of a hopeless love affair. Â  An entire social order is devastated and another of a cruel, forceful system is created to replace it. But such events are merel y shown in a handful and violently acted parts that are shoved abruptly through a scene of the personal tragedy and afterward are as hastily inhibited. The greatest portion of this film is dedicated to the romantic view of the emotional connection and personal miseries of a few bourgeois who are inhumanely troubled and damaged by the larger forces of change. It seems that this tragic love story is the theme upon which the film has decided to resolve the pressures of personal drama and spiritual tension that overwhelmed the Pasternak narrative.

The effects of cell phones in the busness workplace Research Paper - 1

The effects of cell phones in the busness workplace - Research Paper Example Not unusually for breakthrough technology, the cost of a Motorola DynaTac in 1983 was $3,995.00, which, in today’s terms and taking inflation into account, would be in the region of $8,500. (1) The cost of acquisition, however, was overall perceived to be outweighed by the benefits of the new technology and the status conferred on those who used it. The race to produce more affordable, smaller and more versatile handsets for a market that could only grow is till showing little sign of slowing. Gartner Says Worldwide Mobile Phone Sales Grew 17 Per Cent in First Quarter 2010. (2) Figures released in 2002 by the International Telecommunication Union (3) reveal that, in terms of units per person, Taiwan topped the list at 106.45 per 100, with Burma at the bottom. Weighted average was 59.3 per 100, with the United States at 48.81. The cost of initial models confined sales almost exclusively to the business sector, and indeed the benefits were immediate and enormous. On another level, the magical new device lent an aura of power to its owner; if you were in a position to purchase one of these vastly expensive, exotic devices, you clearly needed to communicate with other powerful, decision-making corporate warriors. Either that, or you were a very savvy criminal (3), which, to some sideline observers not yet equipped to enter the game, was also an exotic and enviable career. So we can safely say that the cell phone changed business for the better as soon as it became clear that to not have one was a disadvantage. Let us call this ‘Effect One’, the addition of a vital tool to the company toolbox, sometimes one you had to earn by distinction until the price enabled the purchase of a handset for personal use. It needed little to no effort to sell this new, potent symbol of progress and dynamism. It also introduced a set of changes

The Lung Chronic Disease Bronchopulmonary Dysplasia Nursing Essay

The Lung Chronic Disease Bronchopulmonary Dysplasia Nursing Essay Bronchopulmonary dysplasia or BPD is a form of chronic lung disease that develops in preterm neonates and is treated with oxygen and positive-pressure ventilation (PPV). In this paper I will discuss exactly what bronchopulmonary dysplasia is, its pathophysiology, the etiology, its clinical presentation, and any differential diagnosis of the disease. I will also present in my research the treatment and management for the disease, its prognosis, and the sequelae. Bronchopulmonary dysplasia formerly known as Chronic Lung Disease of Infancy is a chronic lung disorder that is more prevalent in children who were born prematurely with low birthweights, and whose lungs havent had the time to fully develop. White male infants seem to be at a greater risk for development, and genetics may contribute to some of these cases. It is also very common in those who have received prolonged mechanical ventilation to treat respiratory distress syndrome (RDS). It is ironic that the treatment for RDS is considered to be the prime cause of BPD. With the treatment of RDS the patient is treated with high pressures and high FiO2 over a period of time. Its the high pressures of oxygen delivery that can result in necrotizing bronchiolitis and alveolar septal injury; this action further compromises the oxygenation of blood. Bronchopulmonary dysplasia is characterized by inflammation and scarring in the lungs. The signs and symptoms to watch out for are the oxygen deman ds of the infant not decreasing as they should, in some cases even increasing. Fast breathing, a fast heart rate, flared nostrils, retractions, poor weight gain, and coarse crackles may be heard upon auscultation. The pathophysiology of BPD is linked to four factors. These factors are oxygen toxicity, barotrauma, the presence of a PDA (patent ductus arteriosus), and fluid overload. Exposure to high concentrations of oxygen can lead to edema and the thickening of the alveolar membrane. When you have prolonged exposure it causes the alveolar tissues to hemorrhage and become necrotic. As the disease progresses the interstitial spaces will become fibrotic. When the lung tries to heal itself, all of the new cells are damaged by the same factors as before, and it continues in a cycle. All of this can interfere with alveolarization and lead to alveolar simplification with a reduction in the surface area for gas exchange. Any damage to the lung during a critical stage of growth will result in significant pulmonary dysfunction. With patients who have left-to-right shunting through the PDA it is more likely that they develop pulmonary congestion and worsening compliance. With this problem the patient wi ll need higher ventilatory pressures and oxygen percentages to help with ventilation and oxygenation; therefore they have a higher risk of BPD. Bronchopulmonary dysplasia develops as a result of an infants lungs becoming irritated or inflamed. The lungs of premature infants are very fragile and arent fully developed, and therefore they can become easily irritated. Ventilators are used to help with the breathing by using pressure to blow air into the airways and lungs. However it is the pressures used that can irritate and harm a premature infants lungs, so they are used only when absolutely needed. Sometimes oxygen therapy is given to make sure that the infants brains, hearts, livers, and kidneys get enough oxygen to work properly. However in some cases high levels of oxygen can inflame the lining of the lungs and injure the airways, it can also slow lung development. Another cause is infections that can inflame the underdeveloped lungs of premature infants. With this problem it causes narrowing of the airways and makes it harder for infants to breathe. Lung infections can also increase the need for extra oxygen and breathin g support which in turn leads to the ventilation and extra oxygen requirements. There are some studies also show that heredity plays a role in causing BPD. Infants with bronchopulmonary dysplasia will have abnormal findings on physical exams, chestx-rays, pulmonary function testing, and histopathologic examinations. Initial findings observed shortly after birth are consistent with respiratory distress syndrome (RDS). Persistence of these abnormalities can be associated with an increased risk of bronchopulmonary dysplasia. Physical examination may reveal tachypnea, tachycardia, increased work of breathing, including retractions, nasal flaring, and grunting, as well as frequent desaturations and significant weight loss during the first 10 days of life. Infants with severe bronchopulmonary dysplasia are often extremely immature and had a very low birth weight. Their requirements for oxygen and ventilatory support often increase in the first 2 weeks of life. At weeks 2-4, oxygen supplementation, ventilator support, or both are often increased to maintain adequate ventilation and oxygenation. Dif DX Atelectasis refers to collapse of part of the lung. It may include a lung subsegment or the entire lung and is almost always a secondary phenomenon, with no sex or race proclivities; however, it may occur more frequently in younger children than in older children and adolescents. The direct morbidity from atelectasis is transient hypoxemia due to blood flowing through the lung, which does not have normal air flow. The blood does not pick up oxygen from the corresponding alveoli. This shunting results in transient hypoxemia. Hypertension Patent ductus arteriosus (PDA) is one of the more common congenital heart defects. The presentation widely varies. Depending on the size of the patent ductus arteriosus, the gestational age of the neonate, and the pulmonary vascular resistance, a premature neonate may develop life-threatening pulmonary overcirculation in the first few days of life. Conversely, an adult with a small patent ductus arteriosus may present with a newly discovered murmur well after adolescence. During fetal life, the ductus arteriosus is a normal structure that allows most of the blood leaving the right ventricle to bypass the pulmonary circulation and pass into the descending aorta. Typically, only about 10% of the right ventricular output passes through the pulmonary vascular bed. Pneumonia and other lower respiratory tract infections are the leading causes of death worldwide. Because pneumonia is common and is associated with significant morbidity and mortality, properly diagnosing pneumonia, correctly recognizing any complications or underlying conditions, and appropriately treating patients are important. Although in developed countries the diagnosis is usually made on the basis of radiographic findings, the World Health Organization (WHO) has defined pneumonia solely on the basis of clinical findings obtained by visual inspection and on timing of the respiratory rate. (See Clinical Presentation.) Pneumonia may originate in the lung or may be a focal complication of a contiguous or systemic inflammatory process. Abnormalities of airway patency as well as alveolar ventilation and perfusion occur frequently due to various mechanisms. These derangements often significantly alter gas exchange and dependent cellular metabolism in the many tissues and organs that determine survival and contribute to quality of life. Subglottic stenosis (SGS) is a narrowing of the subglottic airway (see image below), which is housed in the cricoid cartilage. The subglottic airway is the narrowest area of the airway because it is a complete, nonexpandable, and nonpliable ring, unlike the trachea, which has a posterior membranous section, and the larynx, which has a posterior muscular section. Tracheomalacia is a structural abnormality of the tracheal cartilage allowing collapse of its walls and airway obstruction. A deficiency and/or malformation of the supporting cartilage exists, with a decrease in the cartilage-to-muscle ratio. Immaturity of the tracheobronchial cartilage is thought to be the cause in type I, whereas degeneration of previously healthy cartilage is thought to produce other types. Inflammatory processes, extrinsic compression from vascular anomalies, or neoplasms may produce degeneration. Diffuse malacia of the airway of the congenital origin improves by age 6-12 months as the structural integrity of the trachea is restored gradually with resolution of the process. Treatment and management Treatment in the NICU is designed to limit stress on infants and meet their basic needs of warmth, nutrition, and protection. Once doctors diagnose BPD, some or all of the treatments used for RDS will continue in the NICU. Such treatment usually includes: Using radiant warmers or incubators to keep infants warm and reduce the chances of infection. Ongoing monitoring of blood pressure, heart rate, breathing, and temperature through sensors taped to the babies bodies. Using sensors on fingers or toes to check the amount of oxygen in the infants blood. Giving fluids and nutrients through needles or tubes inserted into the infants veins. This helps prevent malnutrition and promotes growth. Nutrition is critical to the growth and development of the lungs. Later, babies may be given breast milk or infant formula through feeding tubes that are passed through their noses or mouths and into their throats. Checking fluid intake to make sure that fluid doesnt build up i n the babies lungs. As their condition improves, babies who have BPD are weaned or taken off NCPAP or ventilators slowly, until they can breathe on their own. These infants will likely need to continue getting oxygen therapy for some time. If your infant has moderate to severe BPD, echocardiography may be done every few weeks to months to check his or her pulmonary artery pressure. If your child needs long-term support from a ventilator, he or she will likely have a tracheostomy (TRA-ke-OS-to-me). A tracheostomy is a surgically made hole that goes through the front of the neck and into the trachea (TRA-ke-ah), or windpipe. Your childs doctor will put the breathing tube from the ventilator through the hole. Using a tracheostomy instead of an endotracheal (en-do-TRA-ke-al) tube has several advantages. (An endotracheal tube is a breathing tube inserted through the nose or mouth and into the windpipe.) Long-term use of an endotracheal tube can damage the trachea. This damage may later r equire surgery to correct. A tracheostomy may allow your baby to interact more with you and the NICU staff, start talking, and develop other skills.While your baby is in the NICU, he or she also may need physical therapy. Physical therapy can help strengthen your childs muscles and clear mucus out of his or her lungs.Infants who have BPD can recover, but many spend several weeks or months in the hospital. This allows them to get the care they need. Before your baby goes home, its important for you to learn as much as you can about your childs condition and how its treated. Your baby may continue to have some breathing symptoms after he or she leaves the hospital. Your child will likely continue on all or some of the treatments that were started at the hospital, including:Medicines, such as bronchodilators, steroids, diuretics, and caffeine. Oxygen therapy and/or breathing support from NCPAP or a ventilator. Extra nutrition and calories, which may be given through a feeding tube. Pre ventive treatment with a medicine called palivizumab for severe respiratory syncytial virus (RSV). This common virus leads to mild, cold-like symptoms in adults and older, healthy children. However, in infants-especially those in high-risk groups-RSV can be more serious, leading to severe breathing problems. Your child also should have regular checkups with and timely vaccinations from a pediatrician. This is a doctor who specializes in treating children. If your child needs oxygen therapy or a ventilator at home, a pulmonary specialist may help with long-term medical care and make treatment recommendations. Mechanical ventilation In most cases of bronchopulmonary dysplasia (BPD), respiratory distress syndrome is diagnosed and treated. The mainstay for treating RDS has been surfactant replacement with oxygen supplementation, continuous positive airway pressure (CPAP), and mechanical ventilation. The treatment necessary to recruit alveoli and prevent atelectasis in the immature lung may cause lung injury and activate the inflammatory cascade. Trauma secondary to positive pressure ventilation (PPV) is generally referred to as barotrauma. With the recent focus on a ventilation strategy involving low versus high tidal volume, some investigators have adopted the term volutrauma. Volutrauma suggests the occurrence of lung injury secondary to excessive tidal volume from PPV. The severity of lung immaturity, the fetal milieu, and the effects of surfactant deficiency determine the need for PPV, surfactant supplementation, and resultant barotrauma or volutrauma. With severe lung immaturity, the total number of alveoli is reduced, increasing the positive pressure transmitted to distal terminal bronchioles. In the presence of surfactant deficiency, surface tension forces are increased. Some compliant alveoli may become hyperinflated, whereas other saccules with increased surface tension remain collapsed. With increasing PPV to recruit alveoli and improve gas exchange, the compliant terminal bronchiole and alveolar ducts may rupture, leaking air into the interstitium, with resultant pulmonary interstitial emphysema (PIE). The occurrence of PIE greatly increases the risk of bronchopulmonary dysplasia. Many modes of ventilation and many ventilator strategies have been studied to potentially reduce lung injury, such as synchronized intermittent mechanical ventilation (SIMV), high-frequency jet ventilation (HFJV), and high-frequency oscillatory ventilation (HFOV). Results have been mixed, although some theoretical benefits are associated with these alternative modes of ventilation. Although shorter duration of mechanical ventilation has been demonstrated in some trials of SIMV, most trials have not had a large enough sample size to demonstrate a reduction in bronchopulmonary dysplasia. Systematic reviews suggest that optimal use of conventional ventilation may be as effective as HFOV in improving pulmonary outcomes. Regardless of the high-frequency strategy used, avoidance of hypocarbia and optimization of alveolar recruitment may decrease the risk of bronchopulmonary dysplasia and associated of neurodevelopmental abnormalities. PPV with various forms of nasal CPAP has been reported to decrease injury to the developing lung and may reduce the development of bronchopulmonary dysplasia. In general, centers that use gentler ventilation with more CPAP and less intubation, surfactant, and indomethacin had the lowest rates of bronchopulmonary dysplasia. Oxygen and PPV frequently are life-saving in extremely preterm infants. However, early and aggressive CPAP may eliminate the need for PPV and exogenous surfactant or facilitate weaning from PPV. Some recommend brief periods of intubation primarily for the administration of exogenous surfactant quickly followed by extubation and nasal CPAP to minimize the need for prolonged PPV. This strategy may be most effective in infants without severe RDS, such as many infants with birth weights of 1000-1500 g. In infants who require oxygen and PPV, careful and meticulous treatment can minimize oxygen toxicity and lung injury. Optimal levels include a pH level of 7.2-7.3, a partial pressure of carbon dioxide (pCO2) of 45-55 mm Hg, and a partial pressure of oxygen (pO2) level of 50-70 mm Hg (with oxygen saturation at 87-92%). Assessment of blood gases requires arterial, venous, or capillary blood samples. As a result, indwelling arterial lines are often inserted early in the acute management of RDS. Samples obtained from these lines provide the most accurate information about pulmonary function. Arterial puncture may not provide completely accurate samples because of patient agitation and discomfort. Capillary blood gas results, if samples are properly obtained, may be correlated with arterial values; however, capillary samples may widely vary, and results for carbon dioxide are poorly correlated. Following trends in transcutaneous PO2 andP CO2 may reduce the need for frequent blood gas measurements. Weaning from mechanical ventilation and oxygen is often difficult in infants with moderate-to-severe bronchopulmonary dysplasia, and few criteria are defined to enhance the success of extubation. When tidal volumes are adequate and respiratory rates are low, a trial of extubation and nasal CPAP may be indicated. Atrophy and fatigue of the respiratory muscles may lead to atelectasis and extubation failure. A trial of endotracheal CPAP before extubation is controversial because of the increased work of breathing and airway resistance. Optimization of methylxanthines and diuretics and adequate nutrition may facilitate weaning the infant from mechanical ventilation. Meticulous primary nursing care is essential to ensure airway patency and facilitate extubation. Prolonged and repeated intubations, as well as mechanical ventilation, may be associated with severe upper airway abnormalities, such as vocal cord paralysis, subglottic stenosis, and laryngotracheomalacia. Bronchoscopic evaluation should be considered in infants with bronchopulmonary dysplasia in whom extubation is repeatedly unsuccessful. Surgical interventions (cricoid splitting, tracheostomy) to address severe structural abnormalities are used less frequently today than in the past. Oxygen therapy Oxygen can accept electrons in its outer ring to form free radicals. Oxygen free radicals can cause cell-membrane destruction, protein modification, and DNA abnormalities. Compared with fetuses, neonates live in a relatively oxygen-rich environment. Oxygen is ubiquitous and necessary for extrauterine survival. All mammals have antioxidant defenses to mitigate injury due to oxygen free radicals. However, neonates have a relative deficiency in antioxidant enzymes. The major antioxidant enzymes in humans are superoxide dismutase, glutathione peroxidase, and catalase. Activity of antioxidant enzymes tend to increase during the last trimester of pregnancy, similar to surfactant production, alveolarization, and development of the pulmonary vasculature. Increases in alveolar size and number, surfactant production, and antioxidant enzymes prepare the fetus for transition from a relatively hypoxic intrauterine environment to a relatively hyperoxic extrauterine environment. Preterm birth exposes the neonate to high oxygen concentrations, increasing the risk of injury due to oxygen free radical. Animal and human studies of supplemental superoxide dismutase and catalase supplementation have shown reduced cell damage, increased survival, and possible prevention of lung injury. Evidence of oxidation of lipids and proteins has been found in neonates who develop bronchopulmonary dysplasia. Supplementation with superoxide dismutase in ventilated preterm infants with RDS substantially reduced in readmissions compared with placebo-treated control subjects. Further trials are currently under way to examine the effects of supplementation with superoxide dismutase in preterm infants at high risk for bronchopulmonary dysplasia. Ideal oxygen saturation for term or preterm neonates of various gestational ages has not been definitively determined. In practice, many clinicians have adopted conservative oxygen saturation parameters (ie, 87-92%). A delicate balance to optimally promote neonatal pulmonary (alveolar and vascular) and retinal vascular homeostasis is noted. In the Supplemental Therapeutic Oxygen for Prethreshold Retinopathy of Prematurity (STOP-ROP) trial to reduce severe retinopathy of prematurity (ROP), oxygen saturations of more than 95% minimally affected retinopathy but increased the risk for pneumonia or bronchopulmonary dysplasia. The normal oxygen requirement of a preterm infant is unknown. Pulmonary hypertension and cor pulmonale may result from chronic hypoxia and lead to airway remodeling in infants with severe bronchopulmonary dysplasia. Oxygen is a potent pulmonary vasodilator that stimulates the production of nitric oxide (NO). NO causes smooth muscle cells to relax by activating cyclic guanosine monophosphate. Currently, pulse oximetry is the mainstay of noninvasive monitoring of oxygenation. Repeated episodes of desaturation and hypoxia may occur in infants with bronchopulmonary dysplasia receiving mechanical ventilation as a result of decreased respiratory drive, altered pulmonary mechanics, excessive stimulation, bronchospasm, and forced exhalation efforts. Forced exhalation efforts due to infant agitation may cause atelectasis and recurrent hypoxic episodes. Hyperoxia may overwhelm the neonates relatively deficient antioxidant defenses and worsen bronchopulmonary dysplasia. The patients oxygen requirements are frequently increased during stressful procedures and feedings. Some NICUs have adopted a conservative oxygen saturation policy of maintaining saturations of 88-94%. Caregivers are more likely to follow wide guidelines for ranges of oxygen saturation than narrow ones. Some infants, especially those living at high altitudes, may require oxygen therapy for many months. Transfusion of packed RBCs may increase oxygen-carrying capacity in preterm infants who have anemia (hematocrit The need for multiple transfusions and donor exposures can be minimized by using iron supplementation, a reduction in phlebotomy requirements, and by use of erythropoietin administration. Treatment of inflammation Elevated levels of interleukin-6 and placental growth factor in the umbilical venous blood of preterm neonates are associated with increased incidence of bronchopulmonary dysplasia. This inflammation likely affects alveolarization and vascularization of the pulmonary system of the second-trimester fetus. Fetal sheep exposed to inflammatory mediators or endotoxin develop inflammation and abnormal lung development. Activation of inflammatory mediators has been demonstrated in humans and animal models of acute lung injury. Activation of leukocytes after cell injury caused by oxygen free radicals, barotrauma, infection, and other stimuli may begin the process of destruction and abnormal lung repair that results in acute lung injury then bronchopulmonary dysplasia. Radiolabeled activated leukocytes have been recovered by means of bronchoalveolar lavage (BAL) in preterm neonates receiving oxygen and PPV. These leukocytes, as well as lipid byproducts of cell-membrane destruction, activate the inflammatory cascade and are metabolized to arachidonic acid and lysoplatelet factor. Lipoxygenase catabolizes arachidonic acid, resulting in the production of cytokines and leukotrienes. Cyclooxygenase may also metabolize these byproducts to produce thromboxane, prostaglandin, or prostacyclin. All of these substances have potent vasoactive and inflammatory properties. levels of these substances are elevated in the first days of life, as measured in tracheal aspirates of preterm infants who subsequently develop bronchopulmonary dysplasia. Metabolites of arachidonic acid, lysoplatelet factor, prostaglandin, and prostacyclin may cause vasodilatation, increase capillary permeability with subsequent albumin leakage, and inhibit surfactant function. This effects increase oxygenation and ventilation requirements and potentially increase rates of bronchopulmonary dysplasia Activation of transcription factors such as nuclear factor-kappa B in early postnatal life is associated with death or bronchopulmonary dysplasia. Collagenase and elastase are released from activated neutrophils. These enzymes may directly destroy lung tissue because hydroxyproline and elastin (breakdown products of collagen and elastin) have been recovered in the urine of preterm infants who develop bronchopulmonary dysplasia. Alpha1-proteinase inhibitor mitigates the action of elastases and is activated by oxygen free radicals. Increased activity and decreased function of alpha1-proteinase inhibitor may worsen lung injury in neonates. A decrease in bronchopulmonary dysplasia and in the need for continued ventilator support is found in neonates given supplemental alpha1-proteinase inhibitor. All of these findings suggest the fetal inflammatory response effects pulmonary development and substantially contributes to the development of bronchopulmonary dysplasia. The self-perpetuating cycle of lung injury is accentuated in the extremely preterm neonate with immature lungs. Management of infection Maternal cervical colonization and/or colonization in the neonate with Ureaplasma urealyticum has been implicated in the development of bronchopulmonary dysplasia. Viscardi and colleagues found that persistent lung infection with U urealyticum may contribute to chronic inflammation and early fibrosis in the preterm lung, leading to pathology consistent with clinically significant bronchopulmonary dysplasia.[13] Systematic reviews have concluded that infection with U urealyticum is associated with increased rates of bronchopulmonary dysplasia. Infection-either antenatal chorioamnionitis and funisitis or postnatal infection-may activate the inflammatory cascade and damage the preterm lung, resulting in bronchopulmonary dysplasia. In fact, any clinically significant episode of sepsis in the vulnerable preterm neonate greatly increases his or her risk of bronchopulmonary dysplasia, especially if the infection increases the babys requirement for oxygen and mechanical ventilation. Future management Future management of bronchopulmonary dysplasia will involve strategies that emphasize prevention. Because few accepted therapies currently prevent bronchopulmonary dysplasia, many therapeutic modalities (eg, mechanical ventilation, oxygen therapy, nutritional support, medication) are used to treat bronchopulmonary dysplasia. Practicing neonatologists have observed reduced severities of bronchopulmonary dysplasia in the postsurfactant era. Maintaining PPV and oxygen therapy for longer than 4 months and discharging patients to facilities for prolonged mechanical ventilation is now unusual. Medication Summary Many drug therapies are used to treat infants with severe bronchopulmonary dysplasia (BPD). The efficacy, exact mechanisms of action, and potential adverse effects of these drugs have not been definitively established. A study group from the NICHD and US Food and Drug Administration (FDA) reviewed many of the drugs used to prevent and treat bronchopulmonary dysplasia. Walsh and colleagues concluded that detailed analyses of many of these treatments, as well as long-term follow-up, are needed.[15] Vitamin A supplementation Seven trials of vitamin A supplementation in preterm neonates to prevent bronchopulmonary dysplasia were analyzed for the Cochrane Collaborative Neonatal review. Vitamin A supplementation reduced bronchopulmonary dysplasia and death at 36 weeks postmenstrual age. However, the need for frequent intramuscular injections in extremely premature infants has precluded widespread use of this therapy. Diuretics Furosemide (Lasix) is the treatment of choice for fluid overload in infants with bronchopulmonary dysplasia. It is a loop diuretic that improves clinical pulmonary status and function and decreases pulmonary vascular resistance. Daily or alternate-day furosemide therapy may facilitate weaning from positive pressure ventilation (PPV), oxygenation, or both. Adverse effects of long-term therapy are frequent and include hyponatremia, hypokalemia, contraction alkalosis, hypocalcemia, hypercalciuria, renal stones, nephrocalcinosis, and ototoxicity. Careful parenteral and enteral nutritional supplementation is required to maximize the benefits instead of exacerbating the adverse effects. In patients with mild hyponatremia or hypokalemia, supplementation with potassium chloride is favored over supplementation with sodium chloride. Thiazide diuretics plus aldosterone inhibitors (eg, spironolactone [Aldactone]) have also been used in infants with bronchopulmonary dysplasia. In several trials of infants with bronchopulmonary dysplasia, thiazide diuretics combined with spironolactone increased urine output with or without improvement in pulmonary mechanics. Hoffman et al reported that spironolactone did not reduce the need for supplemental electrolytes in preterm infants with bronchopulmonary dysplasia.[16] To the present authors knowledge, long-term studies to compare the efficacy of furosemide with those of thiazide and spironolactone therapy have not been performed. Bronchodilators Albuterol is a specific beta2-agonist used to treat bronchospasm in infants with bronchopulmonary dysplasia. Albuterol may improve lung compliance by decreasing airway resistance by relaxing smooth muscle cell. Changes in pulmonary mechanics may last as long as 4-6 hours. Adverse effects include increased blood pressure (BP) and heart rate. Ipratropium bromide is a muscarinic antagonist that is related to atropine; however, it may have bronchodilator effects more potent than those of albuterol. Improvements in pulmonary mechanics were demonstrated in patients with bronchopulmonary dysplasia after they received ipratropium bromide by inhalation. Combined therapy with albuterol and ipratropium bromide may be more effective than either agent alone. Few adverse effects are noted. Methylxanthines are used to increase respiratory drive, decrease apnea, and improve diaphragmatic contractility. These substances may also decrease pulmonary vascular resistance and increase lung compliance in infants with bronchopulmonary dysplasia, probably by directly causing smooth muscle to relax. Methylxanthines also have diuretic effects. All of these effects may increase success in weaning patients from mechanical ventilation. Synergy between theophylline and diuretics has been demonstrated. Theophylline has a half-life of 30-40 hours. It is metabolized primarily to caffeine in the liver and may result in adverse effects such as increase in heart rate, gastroesophageal reflux, agitation, and seizures. The half-life of caffeine is approximately 90-100 hours, and caffeine is excreted unchanged in the urine. Both agents are available in intravenous and enteral formulations. Caffeine has fewer adverse effects than theophylline. Schmidt and colleagues reported that the early use of caffeine to treat apnea of prematurity appeared to reduce ventilatory requirements and that it may decrease the incidence of bronchopulmonary dysplasia.[17] Corticosteroids Systemic and inhaled corticosteroids have been studied extensively in preterm infants to prevent and treat bronchopulmonary dysplasia. Dexamethasone is the primary systemic synthetic corticosteroid studied in preterm neonates. Dexamethasone has many pharmacologic benefits but clinically significant adverse effects. This drug stabilizes cell and lysosomal membranes, increases surfactant synthesis, increases serum vitamin A concentration, inhibits prostaglandin and leukotriene, decreases pulmonary edema (PE), breaks down granulocyte aggregates, and improves pulmonary microcirculation. Its adverse effects are hyperglycemia, hypertension, weight loss, GI bleeding or perforation, cerebral palsy, adrenal suppression, and death. Many researchers have evaluated the effects of early administration of dexamethasone to prevent bronchopulmonary dyspl

Copyright Laws in India Essay -- Technology Computers Essays

Copyright Laws in India This document is intended to give a brief overview of the patent and copyrights laws in India and a brief analysis on global issues related to these laws. India has progressed enormously in the field of technology and is ranked tenth in the pool of scientific and technical personnel in the world. There may be hundreds of economical, legal, ethical issues that might have global impact but discussing all of them here is almost impossible. Only the key issues are focused in this paper. India is quickly growing as leading world software producer. It has occupied a secured place in information technology arena by producing high quality software products and software professionals. India also has a fairly well developed system of infrastructure facilities like power, transport, communication and banking. Government of India has recently adopted an increasing liberal approach towards joint venture and import of technology. The country has also revised its patents Acts after a number of foreign companies brought suit against local firms for breach of patents. While computer programs are not currently patentable in India, the country is not without software protection. The Indian Copyright Law explicitly defines the software as a literary work, which can be protected. The statute gives the Indian Central Govt. power to extent copyright protection to foreign works if needed. With the protective necessary statute in place, India has only to enforce them. Enforcement in Ind ia, as in Mexico, indeed seems to be weak spot in controlling intellectual property. We will discuss the details of patens and copyrights issues of India in following sections of this paper. Overview of Patent laws in India The Indian Patent Law does not contain any specific provision regarding the protection of computer programs. Computer programs are not patentable per se, however a claim to a manner of manufacture, which results in a tangible product that requires the application of an algorithm or a particular computer program, may be patentable. Under Section 3(k) of the Patents (Second Amendment) Bill 1999, "a mathematical or a business method or a computer program or algorithms" is not a patentable invention. It appears that computer programs capable of bringing about a technical effect might be allowed, in pursuant to the recommendations made by the... ... of the program to be free software as well.) would prohibit it. Conclusion Software is special . Neither it can be compared to a copyrighted novel nor to a hardware or machinery. Software should be considered as a special case as it forms a unique nexus between the intangible world of abstract concepts and the concrete world of machinery. New discoveries and inventions are taking place everyday in this field. As we discussed above, there are many ethical issues if we protect the software as any other engineering process and there are many issues if we do not protect them. Being a responsible software engineer, I believe that software should be considered as a separate entity (different from other engineering processes or literary work) and new laws should be defined only applicable to software. References i. The patent and copyrights law in India, http://www.singhania.com/ip/contents.html ii. The Danger of Software Patents - by Richard M. Stallman, http://www.gnu.org/philosophy/stallman-mec-india.html iii. Philosophies of Free Software and Intellectual Property - by Brett Watson, http://www.ram.org/ramblings/philosophy/fmp/free-software-philosophy.html